CLINICAL AND HEALTH-CARE COST CONSEQUENCES OF INFECTIVE ENDOCARDITIS IN MITRAL-VALVE PROLAPSE

Although mitral valve prolapse (MVP) predisposes to infective endocard itis (IE), both the clinical consequences of IE and the increment in h ealth care costs it imposes on patients with MVP remain uncertain. Acc ordingly, 21 MVP patients with IE and 41 age- and sex-matched control subjects with initially uncomplicated MVP were followed (95% complete) a mean of 8 years. Outcomes included death, complications, health car e use and cumulative incremental costs. More MVP patients with IE died (25 vs 5%, p <0.05), underwent valve surgery (40 vs 8%, p <0.01), had heart failure (50 vs 5%, p <0.01) or embolization (53 vs 11%, p <0.01 ), underwent cardiac catheterization (40 vs 13%), and saw their physic ians >2 times per year (88 vs 33%). The cumulative incremental cost of IE (1990 dollars) was $46,132 per cage. Thus, IE in patients with MVP causes considerable cumulative morbidity and incremental health care costs.